Gout and its homoeopathic management

AbstractGout is a metabolic disease that most often affects middle-aged to elderly men and postmenopausal women. It results from an increased body pool of urate with hyperuricemia. It typically is characterized by episodic acute arthritis or chronic arthritis caused by deposition of MSU crystals in joints and connective tissue tophi and is a risk factor for deposition in kidney

interstitium or uric acid nephrolithiasis. Homoeopathic remedies are effective in treating acute as well as chronic gout and also helps in reducing the uric acid levels, thus preventing further attacks and other complications of hyperuricemia.

IntroductionGout has been recorded in the medical literature since ancient times and has also been mentioned in the biographies of many distinguished personalities

It is a metabolic disease that results from an increased body pool of urate with hyperuricemia. It typically is characterized by episodic acute arthritis or chronic arthritis caused by deposition of MSU crystals in joints and connective tissue tophi and carries the risk for deposition in kidney interstitium or uric acid nephrolithiasis.

EPIDEMIOLOGYGlobally, the prevalence of hyperuricemia ranges between 2.0 and 13.2%, and the prevalence of gout is between 1.3 and 3.7%. The higher the serum urate level, the more likely an individual is to develop gout.

In the last few decades, the prevalence of hyperuricemia is increasing rapidly in the world population, not only in the developed countries but also in the low and middle-income countries. Lifestyle factors like obesity, purine abundant diet and alcohol intake have been known to favor the development of hyperuricemia.

CAUSESThe main cause for gouty arthritis is the underlying hyperuricemia. That is serum uric acid level more than 6.8 mg/dl.

Uric acid is the end product of endogenous and dietary purine metabolism which is being excreted by the kidneys.

Hyperuricemia occurs when there is

Increased production of uric acid which can be due to:

Dietary factors: liver, red meat, organ meat, shell fish

Alcohol

Decreased uric acid excretion which can be due to:

Decreased glomerular excretion

Decreased tubular secretion

Increased renal absorption

Both

PATHOPHYSIOLOGY

As already told, there will be hyperuricemia due to any of the above mentioned causes.

This elevated uric acid in the blood is saturated and is deposited as monosodium urate crystals.

This crystals usually gets deposited in areas where blood supply is poor like in joint, where it interacts with leucocytes and initiates inflammatory responses resulting in acute gout.

Further attacks of acute gout result in recurrent or chronic gout.

CLINICAL MANIFESTATIONS

ACUTE GOUT

Usually one joint is affected first.

First MTP joint (podagra).

Other common sites are ankle, mid-foot, knee, small joints of hands, wrist and elbow.

USG – can detect subclinical micro-tophi and MSU deposits within cartilage of first MTP joint, even at first clinical presentation.

MANAGEMENT

GENERAL MANAGEMENT

Weight loss.

Reduction of excess alcohol intake, especially beer.

Diuretics should be stopped if possible.

Purine diet should be tempered – sea food, red meat.

HOMOEOPATHIC MANAGEMENTWhat approach a homoeopath has to take while dealing with a gout patient depends upon in which stage the patient presents to the physician.

So if the patient is coming in an acute stage, as it is a very painful condition, the purpose of the treatment should be to manage the pain. So an acute remedy which covers the symptom totality should be given.

And if the patient is coming in a chronic stage of gout, our treatment should be mainly to reduce the uric acid levels and the tendency for uric acid formation along with symptomatic management. So a constitutional remedy covering the uric acid diathesis or gouty diathesis should be ideally given to such patients.

Urtica urens: It’s almost a specific remedy for hyperuricemia. Can be used to reduce uric acid levels even in the absence of symptoms. Pain associated with urticaria like symptoms. Pain in the right deltoid. Pain is worse by rotating arm inwards. Also the affected part is very much sensitive to touch.

Arnica Montana: Complaints arising after an injury or trauma. Constant fear of being touched. Pains unbearable during night. Bed feels so hard. Sensation as if the foot were compressed by a hard body.

Abrotanum: Remedy for gouty deposits around finger joints. Pain is worse during cold and stormy weather. Painful, sore and hot at that time.

Belladonna:Remedy mainly suited for acute stage of gout with much inflammation, with erysipelatous redness and swelling of the joint. Pain is worse during night and cold and it is better by pressure.

Benzoic acid:Useful remedy for acute gout as well as recurrent gout. Gouty attacks going from left to right or commencing in right great toe. Old nodes become painful and as the pains abate palpitation sets in, ceasing only when pain increase. Urine is of highly offensive odour, depositing a reddish cloudy sediment.

Ledum: For cases which are maltreated by excessive dose of colchicum. Lancinating, tearing pains which are worse by motion than by touch and at midnight, when joints feel so hot that he throws off all covering. Oedematous swelling of joint, which may feel cold to the touch. Affects chiefly left shoulder and right hip-joint. Habitual gout in the articulations of hands and feet. Ball of great toe swollen and painful. Soles very sensitive, tendons stiff. Gouty nodosities in joints; fine tearing pains in toes. After abuse of alcoholic drinks.

STAPHYSAGRIA: Arthritic nodes from deposition of urates of soda. Pain from the eyes to the teeth, face sallow. Chronic gout of men advanced in life, corpulent with feeble pulse, palpitation, dyspnoea on exertion.Pains in smaller joints of hands and feet, with much swelling and hardness; skin affections alternating with pains in joints; weakness of knees; soles of feet tender.